Authors
1 Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‑Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran,
3 Department of Epidemiology and Biostatistics, Health Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran,
Abstract
BACKGROUND: Hypertension is a worldwide health issue. Increasing aging has given rise to the
prevalence of this problem. Disease management using educational intervention based on theoretical
frameworks is effective for influencing self‑care behavior. The goal of this study is to investigate the
effects of educational intervention on self‑care behaviors that influence hypertension control among
the elderly population during 2020 based on the health belief model.
MATERIALS AND METHODS: A quasi-experimental study was conducted on rural older people in
Ardestan, Iran. Assessments were done before and after three educational intervention sessions
with a control group. The random sampling has done on 99 hypertensive elderly people in two rural
centers of Ardestan from 2019 to 2020. Awareness variables, components of the health belief model,
and blood pressure were assessed before and three months after the intervention. Data analysis
was done using descriptive and analytical statistics.
RESULTS: The study groups did not differ significantly in terms of the variables studied at the
beginning of the study. After three months, the variables of awareness, self‑care, and perceived
sensitivity constructs, perceived severity, perceived benefits, and guide to action showed a significant
rise in the experimental group compared to the control group. In addition, the effectiveness of
educational intervention significantly increased self‑care behavior in the experimental group.
CONCLUSIONS: Educational intervention based on the health belief model can be effective to
reduce the barriers of self‑care behaviors. In order to have a lasting change in behavior, the use
of behavioral change patterns that ecologically take into account interpersonal, organizational, and
social factors is suggested too.
Keywords
Vartoni SN, et al. Effect of self‑care education on quality of life
in patients with primary hypertension: Comparing lecture and
educational package. Nurs Midwifery Stud 2013;2:71‑6.
2. Oori MJ, Mohammadi F, Norozi K, Fallahi‑Khoshknab M,
Ebadi A, GheshlaghRG. Prevalence of HTN in Iran: Meta‑analysis
of published studies in 2004‑2018. Curr Hypertens Rev
2019;15:113‑22.
3. Ahmadi A, Soori H, Mehrabi Y, Etemad K, Khaledifar A.
Epidemiological pattern of myocardial infarction and modelling
risk factors relevant to in‑hospital mortality: The first results from
the Iranian Myocardial Infarction Registry. Kardiol Pol (Pol Heart
J) 2015;73:451‑7.
4. Sadeghi M, Haghdoost AA, Bahrampour A, Dehghani M.
Modeling the burden of cardiovascular diseases in Iran from 2005
to 2025: The impact of demographic changes. Iran J Public Health
2017;46:506‑16.
5. Bosu WK, Reilly ST, Aheto JM, Zucchelli E. Hypertension in older
adults in Africa: A systematic review and meta‑analysis. PLoS
One 2019;14:e0214934.
6. Organization WH. Global Status Report on Noncommunicable
Diseases 2014. Geneva, Switzerland. World Health
Organization; 2014.
7. Marshall A, Nazroo J, Feeney K, Lee J, Vanhoutte B, Pendleton N.
Comparison of hypertension healthcare outcomes among older
people in the USA and England. J Epidemiol Community Health
2016;70:264‑70.
8. Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N,
et al. Hypertension in older adults: Assessment, management,
and challenges. Clin Cardiol 2020;43:99‑107.
9. Eshah NF, Al‑Daken LI. Assessing publics’ knowledge about
hypertension in a community‑dwelling sample. J Cardiovasc
Nurs 2016;31:158‑65.
10. Daniali SS, Eslami AA, Maracy MR, ShahabiJ, Mostafavi‑Darani F.
The impact of educational intervention on self‑care behaviors in
overweight hypertensive women: A randomized control trial.
ARYA Atheroscler 2017;13:20‑8.
11. Jung H, Lee J‑E. The impact of community‑based eHealth
self‑management intervention among elderly living alone withhypertension. J Telemed Telecare 2017;23:167‑73.
12. Motlagh SF, ChamanR, Sadeghi E, Eslami AA. Self‑care behaviors
and related factors in hypertensive patients. Iran Red Crescent
Med J 2016;18:e35805.
13. Han H‑R, Lee H, Commodore‑Mensah Y, Kim M. Development
and validation of the hypertension self‑care profile: A practical
tool to measure hypertension self‑care. J Cardiovasc Nurs
2014;29:E11‑20.
14. Stoeckel PR. Client Education: Theory and Practice. Sudbury,
Massachusetts: Jones & Bartlett Learning; 2017.
15. Sharma M. Theoretical Foundations of Health Education and
Health Promotion. Sudbury, Massachusetts: Jones & Bartlett
Learning; 2021.
16. Sadeghi R, Mohseni M, Khanjani N. The effect of an educational
intervention according to hygienic belief model in improving care
and controlling among patients with hypertension. J Rafsanjan
Univ Med Sci 2014;13:383‑94.
17. Larki A, Reisi M, Tahmasebi R. Factors predicting self‑care
behaviors among low health literacy hypertensive patients based
on Health Belief Model in Bushehr District, South of Iran. Soc Med
2021;14:4‑12.
18. Imtichan SN, Tamtomo D, Sulaeman ES. Path analysis:
Application of health belief model on the determinants of clean
and healthy behavior among elderly with hypertension. J Health
Promot Behav 2019;4:110‑20.
19. Shirani S, Gharipour M, Khosravi A, Kelishadi R, Habibi HR,
Abdalvand A, et al. Gender differences in the prevalence of
hypertension in a representative sample of Iranian population:
The Isfahan Healthy Heart Program. Acta Biomed 2011;82:223‑9.
20. Xu L, Meng Q, He S, Yin X, Tang Z, Bo H, et al. The effects
of health education on patients with hypertension in China:
A meta‑analysis. Health Educ J 2014;73:137‑49.
21. Poormuhamad S, Jalili Z. Related factors to self‑care behaviors
in elderly with hypertension based on the Health Belief Model
in Uremia County. J Gerontol 2017;2:41‑50.
22. Sharifi DaranI M, Jalili Z, Hasanzadeh A. Impact of health belief
model‑based training on self‑care behavior in elderly people with
hypertension referring to comprehensive health services centers of
Daran City, Iran, during 2017‑18. J Health Syst Res 2019;15:107‑14.
23. Ozoemena EL, Iweama CN, Agbaje OS, Umoke PC, Ene OC,
Ofili PC, et al. Effects of a health education intervention on
hypertension‑related knowledge, prevention and self‑care
practices in Nigerian retirees: A quasi‑experimental study. Arch
Public Health 2019;77:1‑16.
24. Zangiabadi A. Investigating the associated factors with medical
adherence among hypertensive patients based on the health belief
model in Shahdad Area. School of Health, Kerman University of
Medical Sciences, Kerman, Iran. 2019.
25. Hazavehei S, Dashti S, Moeini B, Faradmal J, Shahrabadi R,
Yazdi A. Factors related to self‑care behaviors in hypertensive
individuals based on Health Belief Model. Koomesh 2015;17:37‑44.
26. Ramezanhkani A, Ghaffari M, Etemad K, Fallah F. Effect of the
health belief model based education on hypertension reduction
among elderly women affiliated with Shahid Beheshti University
of Medical Sciences‑2018. J Health Field 2019;6:6‑12.
27. Mirhoseini S, Mazloomy Mahmoodabad SS, Amiri MM,
Alizadeh S. The study of blood pressure related factors based on
health belief model in Yazd in 2017. J Tolooebehdasht 2019.
28. Shameena AU, Badiger S, Nanjesh Kumar S. Medication
adherence and health belief model among hypertensive patients
attending rural health centres of a tertiary care hospital in South
India. Int J Commun Med Public Health 2017;4:1159‑65.
29. Nooriani N, Mohammadi V, Feizi A, Shahnazi H, Askari G,
Ramezanzade E. The effect of nutritional education based on
health belief model on nutritional knowledge, Health Belief
Model constructs, and dietary intake in hemodialysis patients.
Iran J Nurs Midwifery Res 2019;24:372‑8.
30. Khani JA, Hidarnia A, Kaveh MH, Hajizadeh E. The effect of a
prevention program based on health belief model on osteoporosis.
J Res Health Sci 2015;15:47‑53.
31. Mohebi S, Azadbakht L, Feizi A, Sharifirad G, Kargar M. Review
the key role of self‑efficacy in diabetes care. J Educ Health Promot
2013;2:36.
32. Robinson T. Hypertension Beliefs and Behaviors of African
Americans in Selected Cleveland Public Housing. Kent State
University; 2012.
33. Al‑NoumaniH, Wu J‑R, BarksdaleD, SherwoodG, AlkhasawnehE,
Knafl G. Health beliefs and medication adherence in patients with
hypertension: A systematic review of quantitative studies. Patient
Educ Couns 2019;102:1045‑56.
34. Long E, Ponder M, Bernard S. Knowledge, attitudes, and beliefs
related to hypertension and hyperlipidemia self‑management
among African‑American men living in the southeastern United
States. Patient Educ Couns 2017;100:1000‑6.
35. Gaston A, Prapavessis H. Using a combined protection motivation
theory and health action process approach intervention to
promote exercise during pregnancy. J Behav Med 2014;37:173‑84.
36. Lee E, Park E. Self‑care behavior and related factors in older
patients with uncontrolled hypertension. Contemp Nurse
2017;53:607‑21.
37. Babaei S, Shakibazadeh E, Shojaeizadeh D, Yaseri M,
Mohamadzadeh A. Effectiveness the theory‑based intervention
based on health belief model on health promotion lifestyle in
individuals susceptible to cardiovascular diseases. Iran J Health
Educ Health Promot 2020;8:224‑39.
38. MazloomyMahmoodabad SS, Agh Atabay R, Movahed E,
Jadgal KM, Alizadeh S. Predictive control high blood pressure
in patients with hypertension based on health belief model in
Kerman in 2015. Tolooebehdasht 2016;14:98‑106.
39. Hacihasanoğlu R, Gözüm S. The effect of patient education
and home monitoring on medication compliance, hypertension
management, healthy lifestyle behaviours and BMI in a primary
health care setting. J Clin Nurs 2011;20:692‑705.
40. Zafar H, Hall P, Sengupta R, Dineen B, Houlihan A, Sharif R, et al.
Patient empowerment through community‑based hypertension
educational programme in the West of Ireland. SN Compr Clin
Med 2021;3:1096‑105.
41. Magadza C, Radloff S, Srinivas S. The effect of an educational
intervention on patients’ knowledge about hypertension,
beliefs about medicines, and adherence. Res Soc Adm Pharm
2009;5:363‑75.
42. Goyer L, Dufour R, Janelle C, Blais C, L’Abbé C, Raymond E,
et al. Randomized controlled trial on the long‑term efficacy of a
multifaceted, interdisciplinary lifestyle intervention in reducing
cardiovascular risk and improving lifestyle in patients at risk of
cardiovascular disease. J Behav Med 2013;36:212‑24.
43. Keshvari M, Hedayati B, Moeini M, Alhani F. A survey on the
effect of implementation of a family‑centered empowerment
model on blood pressure and empowerment dimensions in the
elderly people with hypertension. J Educ Health Promot 2015;4:94.
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